Provider Demographics
NPI:1598462228
Name:DOMINGUEZ ENRIQUEZ, RUTH K (PA)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:K
Last Name:DOMINGUEZ ENRIQUEZ
Suffix:
Gender:
Credentials:PA
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Mailing Address - Street 1:271 GROVE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1730
Mailing Address - Country:US
Mailing Address - Phone:973-559-3700
Mailing Address - Fax:833-484-1686
Practice Address - Street 1:200 HIGHLAND AVE STE 100B
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1521
Practice Address - Country:US
Practice Address - Phone:973-969-3800
Practice Address - Fax:833-488-1213
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2025-04-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00766000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant